Let’s Kick TB out of PNG

Systematic screening for tuberculosis launches in Papua New Guinea

Lolita Stocks is the first person to step into the TB Van for screening after its inauguration 5 February on Daru Island in Papua New Guinea’s Western Province.

For the first time ever, Papua New Guinea has launched systematic screening for tuberculosis in Daru Island in the Western Province with everyone 10 years of age and older being checked for the deadly disease.

Papua New Guinea has the highest TB incidence in the Western Pacific region and 10th highest globally. Multi-drug resistant TB (MDR-TB) rates are rising rapidly. As of 2016, there are about 2000 new cases of MDR-TB in the country. Health authorities worry about projections that MDR-TB will become the dominant strain in PNG in 10 years unless action is taken. Globally, MDR-TB patients have a treatment success rate of less than 50%, and the cost of treatment is a hundred times more than for general TB patients.

Daru is one of the highest TB and MDR-TB burden areas in Papua New Guinea. The island was declared a “hotspot” for MDR-TB in 2014; one in ten TB cases in the area is multidrug resistant. Daru detects around 500 new TB cases every year, which is about 3 percent of its 17,000 population. Now health authorities are concerned that cases of extremely-drug resistant TB (XDR-TB) have also been diagnosed in the area.

With the systematic population screening, health workers will screen for all types of tuberculosis (TB), including drug-resistant strains that threaten the effectiveness of standard TB remedies.

The National Department of Health heads an emergency response team formed in 2015 to coordinate stakeholder efforts. The World Health Organization (WHO) supports the team’s efforts as co-chair and secretariat, including the TB screening initiative.

To bring screening services closer to home, last week the health department launched a new TB van with digital X-ray and computer-aided diagnostic technology. On the side of the van, national rugby star Ase Boas is shown kicking a ball towards the slogan “Let’s Kick TB out of PNG!”.

The launch ceremony was attended by a host of development partners, including WHO, the World Bank, and Australia’s Department of Foreign Affairs and Trade.

Launching of the TB van, from left: Dr Tim Evans, Senior Director, Health, Nutrition and Population Global Practice, World Bank Group; Dr Paison Dakulala, Deputy Secretary, NDOH; Alice Honjepari, Provincial Health, Dr Maggie Taune, Daru General Hospital; Mr Ben David, Minister Counsellor Policy & Health Response, DFAT; and Dr Luo Dapeng, WHO Representative in PNG

“The people see the van as a symbol of hope: that help has come to fight TB at their very doorstep, and perhaps even end it for good,” said Sandra Wanakrah, WHO Systematic Screening Initiative Coordinator in Daru. “For once, the spotlight on Daru is positive, instead of the constant negativity associated with TB.”

Ms Lolita Stocks, 42, was the first resident to be screened for TB using the TB van. This was her first-ever time to be screened for TB. She said she was nervous but happy she and her family were being checked. “It’s very easy and accessible. And it’s good to know our TB status for sure so we can get the right treatment if need be,” she said.

Luckily, she and her family are free from TB disease for now. But they have been advised to return for further checks if they develop any TB symptoms in the future. Those who test positive will immediately get confirmatory test and confirmed TB cases will commence monitored treatment.

TB is typically spread from person to person through the air – for example, when an infected person coughs or sneezes.

To date, Daru has made progress in tackling this deadly disease, including earlier diagnosis and identification of cases, strengthened case management and infection control. Community posts called DART sites (Daru Accelerated Response for TB) have increased patient awareness and adherence to TB treatment significantly in recent years.

The WHO Representative in Papua New Guinea, Dr Luo Dapeng, explained that earlier diagnosis helps strengthen the TB response. “It will enable early treatment of TB patients, meaning better outcomes for patients, and it will help stop the disease being transmitted,” he said. “It will also give us a clearer understanding of the TB burden in Daru Island – on the basis of which we can then develop further evidence-based strategies for addressing this major public health challenge.”

A delegation of partners from the health department, WHO, World Bank and Australia’s Department of Foreign Affairs and Trade flew to Daru last week to attend the launch of the screening. They were joined by implementing partners Health and HIV Implementation Services Provider, World Vision, the Burnett Institute, Daru General Hospital and the Provincial Health Office.

“We are making progress in the TB response,” added Dr Luo. “This is a direct result of very solid partnerships and strong commitment by all our partners working together in the Emergency Response Team.”

Deputy Secretary for Health Dr Paison Dakulala welcomed the team effort to fight TB, including the newest partner, the World Bank. ”Partnership and a strong community response are crucial to progress – in order to Kick TB out of Daru Island, and essentially, out of PNG.”

With the lessons learnt in Daru, the systematic TB screening initiative will be replicated in other high-burden areas.